Gallbladder disease,primary cholelithiasis,or gallbladder hydrops: review of 32 children

Gallbladder disease is generally considered uncommon in childhood, but in recent years the frequency seems to be increasing. Therefore, a review was made of children appearing with gallbladder disease during the past 10 years at the Department of Pediatric Surgery, St. Göran's Hospital, Stockholm. There were 32 patients, 15 boys and 17 girls. Two-thirds of the cases were diagnosed in 1988 or later. One-half were younger than 8 years; 7 were 2 years old or younger. Hemolytic disease was found in 2/32 patients. One patient had received total parenteral nutrition, but only for a period of 10 days. In 6/32 children the symptoms were interpreted to be caused by gallbladder dysfunction, either as intermittent hydrops or a defect of emptying after a fatty meal. One of these 6 also had a stone. Surgery was performed in 22 children: cholecystectomy in 15 and cholecystotomy with stone extraction in 7. Analysis of 14 stones showed that pigmentary stones were most common. We conclude that gallbladder disease in children seems to be increasing. The preoperative examination should include both ultrasound and cholecystography. We also find that stone extraction is an adequate procedure if there is good gallbladder function and no sign of cholecystitis. Correpondence: M.-L. Molander     

Completely or nearly identical hepatitis B virus strains replicate between patients with acute or fulminant hepatitis B and their respective infectious sources

Five patients with acute hepatitis B and four with fulminant hepatitis B were selected for sequencing of the precore/core gene of the virus strains. Furthermore, identical sequencing was done with the HBV of the infectious sources, i.e., the sexual partner in eight cases and a natural child (chronic carrier) infecting the mother in one case. Of the subjects responsible for the infection, four were healthy HBV carriers, three suffered from chronic hepatitis B, and one from acute and one from fulminant hepatitis B. The nucleotide sequences of HBV from both the patients and the implicated sources of infection exhibited perfect identity of the precore region and perfect or high identity of the core region. The completely or nearly identical strain of virus seemed to proliferate successively in the patients following the transmission from the infecting individuals regardless of sequence variations and infectious status. In two cases a peculiar pattern of infection and disease was found: In one married couple the husband, during the incubation period of acute hepatitis B, infected his wife, who developed fulminant hepatitis. In another married couple, both partners ultimately developed fulminant hepatitis (the wife being the source of the infection). © 1994 Wiiey-Liss, Inc.     

Do organic solvents induce changes in the dopaminergic system? Positron emission tomography studies of occupationally exposed subjects

Objectives: The objective of this study was to test the hypothesis that long-term occupational exposure to organic solvents may effect the levels and turnover of dopamine in man. Methods: A study was performed on 17 patients with neuropsychiatric symptoms due to occupational solvent exposure, and 11 healthy non-exposed male volunteers (controls). Positron emission tomography (PET) was used to assess striatal dopaminergic function, using l-[¹¹C]DOPA, [¹¹C]nomifensine and [¹¹C]raclopride as tracers. Results: The rate of dopamine synthesis was significantly increased among subjects with occupational exposure to organic solvents compared with non-exposed controls. After controlling for the difference in age between exposed and controls, the effect of solvent exposure became less apparent and was reduced from +32% (P = 0.009) to +25% (P = 0.07). There were no differences with regard to the binding of [¹¹C]nomifensine. Patients with and without the diagnosis of toxic encephalopathy did not differ with regard to their putaminal uptake of l-[¹¹C]DOPA, [¹¹C]nomifensine and [¹¹C]raclopride. Conclusion: The data support the hypothesis that long-term exposure to organic solvents may increase the rate of dopamine synthesis in the brain without affecting the number of presynaptic terminals or postsynaptic dopamine receptors. Received: 8 October 1996 / Accepted: 7 February 1997     

Chemokine-mediated distribution of dendritic cell subsets in renal cell carcinoma

Background  

Renal cell carcinoma (RCC) represents one of the most immunoresponsive cancers. Antigen-specific vaccination with dendritic cells (DCs) in patients with metastatic RCC has been shown to induce cytotoxic T-cell responses associated with objective clinical responses. Thus, clinical trials utilizing DCs for immunotherapy of advanced RCCs appear to be promising; however, detailed analyses concerning the distribution and function of DC subsets in RCCs are lacking.     

Clozapine: Dopamine D1 Receptor Agonism in the Prefrontal Cortex as the Code to Decipher a Rosetta Stone of Antipsychotic Drugs

Abstract: A large number of ligand binding studies have shown that clozapine has a number of receptor affinities, including those of the dopamine (DA) D₁ and D₂ receptor families. The study of intrinsic efficacy at these receptors is less straightforward. In the experiments summarised here, evidence is presented that clozapine behaves as an agonist at DA D₁ receptors. Thus, the hypothermia produced by clozapine (2.5 mg kg^–1) in the rat is fully antagonised by either of the selective DA D₁ receptor antagonists SCH-23390 (0.1 mg kg^–1) or NNC-687 (4 mg kg^–1). These results provide an intriguing explanation for the clinical profile of clozapine as an atypical antipsychotic drug. Thus, there are supporting clinical and laboratory observations implicating DA D₁ receptors in the prefrontal cortex in cognitive functions. Finally, clozapine displays features with regard to extrapyramidal motor mechanisms, and seizure thresholds, that could be explained by its properties as a DA D₁ receptor agonist.     

Impact of internal capsule lesions on outcome of motor hand function at one year post-stroke.

OBJECTIVE: To investigate the association between damage to different levels of the corticofugal tract and long-term hand motor recovery. DESIGN: Prospective cohort study. PATIENTS: Seventy-five first-ever middle cerebral artery stroke survivors. METHODS: Hand motor function was assessed with the Fugl-Meyer Motor Assessment Scale at one year post-stroke. Localization of the corticofugal tract was assessed on axial magnetic resonance imaging slices using a corticofugal mask defining involvement of the motor cortex, corona radiata or internal capsule and combinations of these structures, adjusted for lesion volume. RESULTS: Longitudinal involvement of all 3 levels of the corticofugal tract and partial involvement of the internal capsule were associated with a significant probability of poor motor hand function recovery. The probability of regaining hand function ranged from 54% if the corticofugal tract was only partly affected to 13% if both motor cortex and internal capsule were affected. CONCLUSION: At one year post-stroke, lesions of the internal capsule were associated with a significantly lower probability of return of isolated hand motor function than lesions of the cortex, subcortex and corona radiata. Since recovery of isolated hand and finger movements is important for regaining a functional upper limb in everyday living, these patients should be identified early post-stroke in order to evaluate specific hand function training.